肝右后下静脉在肝脏外科中的临床应用进展
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摘要
目的了解目前肝右后下静脉(IRHV)在肝脏外科中的临床应用进展并为其临床应用提供依据。方法复习近年来关于IRHV在肝脏外科中临床应用进展的相关文献并加以综述。结果 IRHV作为肝短静脉的一种,直接注入下腔静脉,常与Ⅵ段门静脉伴行;其并不存在于所有个体中,尸体解剖出现率为80%～90%,影像学检测出现率为10%～30%;口径为0.22～0.95 cm,其口径与肝右静脉口径呈负相关性;IRHV对布加综合征分型及治疗方法有着重要意义;IRHV主要引流Couinaud肝脏分段法的第Ⅵ段肝实质静脉血,IRHV的存在扩大了肝切除术的适应证范围,在肝移植术中重建IRHV既能保留供肝的功能,又能在其他主肝静脉发生急性闭塞时代偿性地引流相应肝脏区域。结论 IRHV在肝脏外科中具有重要的临床意义,充分研究其走行特点及毗邻关系有重要作用,不仅可在手术中避免对其损伤,同时可为相关肝脏外科疾病提供新的治疗思路。
Objective To summarize clinical applications of inferior right hepatic vein(IRHV) in liver surgery and to provide a basis for clinical applications of IRHV. Method The relevant literatures about clinical applications of IRHV in liver surgery in recent years were reviewed. Results As a kind of short hepatic veins, the IRHV directly flowed into the inferior vena cava, often accompanied by the portal vein of the segment Ⅵ. The occurrence rate of IRHV was 80%–90% by the autopsy examination, while which was 10%–30% by the imaging examination. The caliber of IRHV was 0.22–0.95 cm, and its caliber was negatively correlated with the caliber of right hepatic vein. The IRHV played a great role in the classification and treatment of the Budd-Chiari syndrome. According to the Couinaud liver classification method, the IRHV mainly drained the blood of segment Ⅵ. The existence of IRHV expanded the indications of hepatectomy. The reconstruction of IRHV in the liver transplantation could not only reserve the function of donor liver, but could compensatively drain the corresponding liver areas if the acute occlusion of other major hepatic veins happened. Conclusions IRHV has some important clinical significances in liver surgery. Fully studying course characters and adjacent relationship of IRHV can not only avoid injury during surgery, but also provide a new treatment idea for related liver diseases.
Objective To summarize clinical applications of inferior right hepatic vein(IRHV) in liver surgery and to provide a basis for clinical applications of IRHV. Method The relevant literatures about clinical applications of IRHV in liver surgery in recent years were reviewed. Results As a kind of short hepatic veins, the IRHV directly flowed into the inferior vena cava, often accompanied by the portal vein of the segment Ⅵ. The occurrence rate of IRHV was 80%–90% by the autopsy examination, while which was 10%–30% by the imaging examination. The caliber of IRHV was 0.22–0.95 cm, and its caliber was negatively correlated with the caliber of right hepatic vein. The IRHV played a great role in the classification and treatment of the Budd-Chiari syndrome. According to the Couinaud liver classification method, the IRHV mainly drained the blood of segment Ⅵ. The existence of IRHV expanded the indications of hepatectomy. The reconstruction of IRHV in the liver transplantation could not only reserve the function of donor liver, but could compensatively drain the corresponding liver areas if the acute occlusion of other major hepatic veins happened. Conclusions IRHV has some important clinical significances in liver surgery. Fully studying course characters and adjacent relationship of IRHV can not only avoid injury during surgery, but also provide a new treatment idea for related liver diseases.
引文
1刘树伟,王怀经,徐文香,等.肝右后静脉的应用解剖.中华外科杂志,1991.29(11):708-710.
2王海全,邢雪,孙国锋.主肝静脉和肝短静脉的解剖学研究及其临床意义.中国普通外科杂志,2007,16(8):767-769.
3 Makuuchi M, Hasegawa H, Yamazaki S, et al. The inferior right hepatic vein:ultrasonic demonstration. Radiology, 1983, 148(1):213-217.
4 Fang CH, You JH, Lau WY, et al. Anatomical variations of hepatic veins:three-dimensional computed tomography scans of 200subjects. World J Surg, 2012, 36(1):120-124.
5 Akgul E, Inal M, Binokay F, et al. The prevalence and variations of inferior right hepatic veins on contrast-enhanced helical CT scanning. Eur J Radiol, 2004, 52(1):73-77.
6王莉,薛雁山,胡齐,等.IRHV的CT影像解剖学研究及其临床意义.中国医学影像学杂志,2009, 17(1):28-31.
7沈柏用,施源.肝脏分段解剖的新认识.世界华人消化杂志,2008,16(9):913-918.
8邢雪.肝静脉外科.北京:人民卫生出版社,2005:78-92.
9牛朝诗,韩卉,耿小平.下腔静脉与肝静脉的外科应用解剖.肝胆外科杂志,1996, 4(1):36-39.
10张我华,孙善全.肝静脉口和下腔静脉肝后段的应用解剖研究.重庆医学院学报,1984, 9(3):151-157.
11罗昆仑,方征,余锋,等.肝后隧道手术高危区的解剖特点及临床应用研究.中国普通外科杂志,2012, 21(1):1-4.
12 Zhang Y, Li Z, Liu S, et al. The study on sectional anatomy and imaging of accessory hepatic veins. Surg Radiol Anat, 2009, 31(10):739-743.
13李林坤.肝右后下静脉3.0 T磁共振VIBE序列影像解剖学研究.临功床放射学杂志,2016, 35(8):1199-1202.
14 Champetier J, Haouari H, Le Bas JF, et al. Large inferior right hepatic vein. Clinical implications. Surg Radiol Anat, 1993, 15(1):21-29.
15 Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet, 1981, 152(1):43-50.
16赵静,杨广奇,沈静娴,等.64排螺旋CT血管成像评价肝静脉解剖三维方位及变异.中华消化病与影像杂志(电子版),2013,3(2):19-23.
17 Tani K, Shindoh J, Akamatsu N, et al. Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation.HPB(Oxford), 2016,18(12):1031-1038.
18 Hanaoka J, Shimada M, Uchiyama H, et al. A simple formula to calculate the liver drainage volume of the accessory right hepatic vein using its diameter alone. Surgery, 2009,146(2):264-268.
19 Cheng YF, Huang TL, Chen CL, et al. Variations of the middle and inferior right hepatic vein:application in hepatectomy. J Clin Ultrasound, 1997, 25(4):175-182.
20 Shilal P, Tuli A. Anatomical variations in the pattern of the right hepatic veins draining the posterior segment of the right lobe of the liver. J Clin Diagn Res, 2015, 9(3):AC08-AC12.
21 De Cecchis L, Hribernik M, Ravnik D, et al. Anatomical variations in the pattern of the right hepatic veins:possibilities for type classification. J Anat, 2000, 197 Pt 3:487-493.
22李虹璐,乔英.肝段下腔静脉引流属支的MSCT解剖及血管成像研究.山西医科大学,2016.
23李杰,李传福.肝右后下静脉的超声研究及临床意义.中国超声医学杂志,1999,15(11):826-827.
24张彦,李振平,粱邦领,等.副肝静脉的影像解剖学研究.医学影像学杂志,2006,16(2):116-119.
25 Ng YY, Finn JP, Hall-Craggs MA. Inferior right hepatic veins:MR assessment of prevalence and potential clinical significance in children. Pediatr Radiol, 1990,20(8):605-607.
26徐慧婷,徐凯,何鹏,等.肝脏三维容积超快速多期动态增强磁共振成像在布加综合征副肝静脉检出中的应用价值.中华肝脏病杂志,2016, 24(8):585-589.
27姚斐斐,程敬亮,杨子涛,等.3.0 T非对比剂肝门静脉磁共振血管成像技术研究.中国医学影像学杂志,2013, 21(11):853-856.
28祖茂衡,徐浩,顾玉明,等.副肝静脉在Budd-Chiari综合征诊断与治疗中的价值.中华放射学杂志,1998, 32(9):616-619.
29 Fu YF, Wei N, Wu Q, et al. Use of accessory hepatic vein intervention in the treatment of Budd-Chiari syndrome.Cardiovasc Intervent Radiol, 2015, 38(6):1508-1514.
30顾玉明,祖茂衡,徐浩,等.副肝静脉成形术在Budd-Chiari综合征治疗中的应用.中华放射学杂志,2003, 37(1):29-32.
31杨宁,杨广顺.原发性肝癌合并门静脉高压症的诊疗现状.中华肝胆外科杂志,2004, 10(10):711-714.
32 Hwang S, Lee SG, Park KM, et al. Quilt venoplasty using recipient saphenous vein graft for reconstruction of multiple short hepatic veins in right liver grafts. Liver Transpl, 2005, 11(1):104-107.
33 Makuuchi M, Hasegawa H, Yamazaki S, et al. Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet,1987,164(1):68-72.
34 Xing X, Li H, Liu WG. Hepatic segmentectomy combined with major hepatic vein resection for preserving remnant liver lobe.Hepatobiliary Pancreat Dis Int, 2008, 7(2):165-168.
35 Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver:a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg, 2001,193(1):109-111.
36彭淑牖,曹利平,李江涛,等.肝后隧道的建立与绕肝带的使用在高难度肝切除术中的作用.中华医学杂志,2003,83(19):1644-1647.
37 Kwak BJ, Kim DG, Han JH, et al. Clinical outcome of 1 000consecutive cases of liver transplantation:a single center experience. Ann Surg Treat Res, 2018,95(5):267-277.
38韦力,李启强,彭民浩,等.肝静脉、肝短静脉注入下腔静脉壁处在肝移植术中的应用.中国局解手术学杂志,1999, 8(3):177-179.
39 Ito K, Akamatsu N, Tani K, et al. Reconstruction of hepatic venous tributary in right liver living donor liver transplantation:The importance of the inferior right hepatic vein. Liver Transpl, 2016,22(4):410-419.
2王海全,邢雪,孙国锋.主肝静脉和肝短静脉的解剖学研究及其临床意义.中国普通外科杂志,2007,16(8):767-769.
3 Makuuchi M, Hasegawa H, Yamazaki S, et al. The inferior right hepatic vein:ultrasonic demonstration. Radiology, 1983, 148(1):213-217.
4 Fang CH, You JH, Lau WY, et al. Anatomical variations of hepatic veins:three-dimensional computed tomography scans of 200subjects. World J Surg, 2012, 36(1):120-124.
5 Akgul E, Inal M, Binokay F, et al. The prevalence and variations of inferior right hepatic veins on contrast-enhanced helical CT scanning. Eur J Radiol, 2004, 52(1):73-77.
6王莉,薛雁山,胡齐,等.IRHV的CT影像解剖学研究及其临床意义.中国医学影像学杂志,2009, 17(1):28-31.
7沈柏用,施源.肝脏分段解剖的新认识.世界华人消化杂志,2008,16(9):913-918.
8邢雪.肝静脉外科.北京:人民卫生出版社,2005:78-92.
9牛朝诗,韩卉,耿小平.下腔静脉与肝静脉的外科应用解剖.肝胆外科杂志,1996, 4(1):36-39.
10张我华,孙善全.肝静脉口和下腔静脉肝后段的应用解剖研究.重庆医学院学报,1984, 9(3):151-157.
11罗昆仑,方征,余锋,等.肝后隧道手术高危区的解剖特点及临床应用研究.中国普通外科杂志,2012, 21(1):1-4.
12 Zhang Y, Li Z, Liu S, et al. The study on sectional anatomy and imaging of accessory hepatic veins. Surg Radiol Anat, 2009, 31(10):739-743.
13李林坤.肝右后下静脉3.0 T磁共振VIBE序列影像解剖学研究.临功床放射学杂志,2016, 35(8):1199-1202.
14 Champetier J, Haouari H, Le Bas JF, et al. Large inferior right hepatic vein. Clinical implications. Surg Radiol Anat, 1993, 15(1):21-29.
15 Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet, 1981, 152(1):43-50.
16赵静,杨广奇,沈静娴,等.64排螺旋CT血管成像评价肝静脉解剖三维方位及变异.中华消化病与影像杂志(电子版),2013,3(2):19-23.
17 Tani K, Shindoh J, Akamatsu N, et al. Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation.HPB(Oxford), 2016,18(12):1031-1038.
18 Hanaoka J, Shimada M, Uchiyama H, et al. A simple formula to calculate the liver drainage volume of the accessory right hepatic vein using its diameter alone. Surgery, 2009,146(2):264-268.
19 Cheng YF, Huang TL, Chen CL, et al. Variations of the middle and inferior right hepatic vein:application in hepatectomy. J Clin Ultrasound, 1997, 25(4):175-182.
20 Shilal P, Tuli A. Anatomical variations in the pattern of the right hepatic veins draining the posterior segment of the right lobe of the liver. J Clin Diagn Res, 2015, 9(3):AC08-AC12.
21 De Cecchis L, Hribernik M, Ravnik D, et al. Anatomical variations in the pattern of the right hepatic veins:possibilities for type classification. J Anat, 2000, 197 Pt 3:487-493.
22李虹璐,乔英.肝段下腔静脉引流属支的MSCT解剖及血管成像研究.山西医科大学,2016.
23李杰,李传福.肝右后下静脉的超声研究及临床意义.中国超声医学杂志,1999,15(11):826-827.
24张彦,李振平,粱邦领,等.副肝静脉的影像解剖学研究.医学影像学杂志,2006,16(2):116-119.
25 Ng YY, Finn JP, Hall-Craggs MA. Inferior right hepatic veins:MR assessment of prevalence and potential clinical significance in children. Pediatr Radiol, 1990,20(8):605-607.
26徐慧婷,徐凯,何鹏,等.肝脏三维容积超快速多期动态增强磁共振成像在布加综合征副肝静脉检出中的应用价值.中华肝脏病杂志,2016, 24(8):585-589.
27姚斐斐,程敬亮,杨子涛,等.3.0 T非对比剂肝门静脉磁共振血管成像技术研究.中国医学影像学杂志,2013, 21(11):853-856.
28祖茂衡,徐浩,顾玉明,等.副肝静脉在Budd-Chiari综合征诊断与治疗中的价值.中华放射学杂志,1998, 32(9):616-619.
29 Fu YF, Wei N, Wu Q, et al. Use of accessory hepatic vein intervention in the treatment of Budd-Chiari syndrome.Cardiovasc Intervent Radiol, 2015, 38(6):1508-1514.
30顾玉明,祖茂衡,徐浩,等.副肝静脉成形术在Budd-Chiari综合征治疗中的应用.中华放射学杂志,2003, 37(1):29-32.
31杨宁,杨广顺.原发性肝癌合并门静脉高压症的诊疗现状.中华肝胆外科杂志,2004, 10(10):711-714.
32 Hwang S, Lee SG, Park KM, et al. Quilt venoplasty using recipient saphenous vein graft for reconstruction of multiple short hepatic veins in right liver grafts. Liver Transpl, 2005, 11(1):104-107.
33 Makuuchi M, Hasegawa H, Yamazaki S, et al. Four new hepatectomy procedures for resection of the right hepatic vein and preservation of the inferior right hepatic vein. Surg Gynecol Obstet,1987,164(1):68-72.
34 Xing X, Li H, Liu WG. Hepatic segmentectomy combined with major hepatic vein resection for preserving remnant liver lobe.Hepatobiliary Pancreat Dis Int, 2008, 7(2):165-168.
35 Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver:a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg, 2001,193(1):109-111.
36彭淑牖,曹利平,李江涛,等.肝后隧道的建立与绕肝带的使用在高难度肝切除术中的作用.中华医学杂志,2003,83(19):1644-1647.
37 Kwak BJ, Kim DG, Han JH, et al. Clinical outcome of 1 000consecutive cases of liver transplantation:a single center experience. Ann Surg Treat Res, 2018,95(5):267-277.
38韦力,李启强,彭民浩,等.肝静脉、肝短静脉注入下腔静脉壁处在肝移植术中的应用.中国局解手术学杂志,1999, 8(3):177-179.
39 Ito K, Akamatsu N, Tani K, et al. Reconstruction of hepatic venous tributary in right liver living donor liver transplantation:The importance of the inferior right hepatic vein. Liver Transpl, 2016,22(4):410-419.